W1- Fracture Evaluation Flashcards
What is the most common MOI for presentations requiring radiology services?
Trauma
Which modalities are commonly used for trauma assessment? (3)
- ) Radiograph
- ) CT (complex anatomy)
- ) MRI (soft tissue injury and subtle fractures)
What are the goals of radiology? (3)
- ) Dx and Evaluate characteristics
- ) Compare w/ clinical Hx/reported MOI
- ) Assess/monitor for response to Tx, healing, and complications
What is the difference between primary and secondary trauma survey?
- Primary = Imaging initially administered in ED to help screen and prioritize injuries.
- Secondary = F/u imaging necessary once pt is clinically stable.
What are the set of procedures commonly done when a pt comes in with high-velocity injury? (3) (vs directly to CT)
- ) Cross-table lateral of the c-spine
- ) AP Chest
- ) AP Pelvis
What are some additional procedures that may be done with a pt presenting with a high-velocity injury? (6)
- Focused Abdominal Ultrasound for Trauma (FAST)
- CT of head
- CT of C-spine
- CT of thorax, abdomen, pelvis
- Lateral T/L spine radiograph
- Extremity radiographs
List possible complications from the following injuries:
- Pelvic/Femur Fx
- Multiple/crushing type Fx
- Elbow Fx
- Proximal humeral Fx
- Shoulder dislocation
- Elbow dislocation
- Hip dislocation
- Knee dislocation
- Pelvic/Femur Fx = Hemorrhage
- Multiple/crushing type Fx = Fat embolism
- Elbow Fx = Brachial artery injury
- Proximal humeral Fx = Axillary nerve injury
- Shoulder dislocation = Axillary artery/nerve injury, Brachial plexus
- Elbow dislocation = Brachial artery injury, Median/Ulnar nerve injury
- Hip dislocation = Femoral artery/nerve injury
- Knee dislocation = Popliteal artery injury, peroneal nerve injury
With trauma, __-_____ is critical.
c-spine
Extremity Fx:
- > /= __ views that are ____ degrees from each other.
- ____ and ______ views when possible.
- Include _______ joints.
- > /=2 views, 90 degrees
- AP and lateral
- adjacent
What are the 2 types of bone?
- Cancellous = spongy
- Cortical = dense
What are some ways to describe fractures? (8)
- ) Open vs Closed
- ) Anatomical site and extent
- ) Type (complete vs incomplete)
- ) Alignment of fragments
- ) Direction of fracture lines
- ) Special features
- ) Associated abnormalities
- ) Special types
What is the difference between a open and closed fracture?
- Open Fx = breaks skin barrier
- Closed Fx = doesn’t break skin barrier
- Long bones are divided into ______.
- Ends are further divided into ______ and _________
- thirds (proximal, middle, distal)
- intra and extraarticular
What is the difference between a complete and incomplete fracture?
- Complete = All cortices disrupted.
- Incomplete = Bone not broken into 2 pieces and is mostly in short bones and children.
> 2 fragments = _______ Fx
Comminuted Fx
What is important to note in regards to the alignment of fractures?
Displaced vs Non-displaced
- Direction of displacement
- Amount of displacement
- Distraction, overriding, rotation
Alignment vs Angulation
-Longitudinal relationship of fragments
- Direction of fracture lines are in reference to the ________ axis.
- What are (4) directions of fracture lines?
- longitudinal
- transverse, longitudinal, oblique, spiral
- What is a impaction Fx?
- What is an avulsion Fx?
Impaction Fx
-Compression with axial load.
Avulsion
-Tensile loading of fragment and main body of bone. (muscle contraction or passive loading)
Pediatric Fx:
- Greenstick = Fx on side of _______ loading.
- Torus = Fx on side of _____ loading.
- What is plastic bowing?
- Greenstick = Fx on tensile side
- Torus = Fx on compressive side
- Plastic Bowing = Longitudinal compression forces exerted, capacity for elastic recoil exceeded.
Describe the first 5 types of Pediatric Physeal Fractures.
Type I (S) -Growth plate only.
Type II (A) -Physis and metaphysis.
Type III (L) -Physis and epiphysis.
Type IV (T) -Epiphysis, physis, and metaphysis.
Type V (R) -Crush injury of physis.
Slipped, Above, Lower, Through, Ruined
Type VI (Rang’s) Pediatric Physeal Fracture involves the ___________ or associated periosteum of physis.
-perichondrial ring
Type VII-IX (Ogden’s) do not directly involve physis, though may disrupt _____ _______.
-blood supply
- Type VII = osteochondral Fx of _______
- Type VIII = Fx of _________
- Type IX = _______ of periosteum
- epiphysis
- metaphysis
- avulsion
What are some concerns for pediatric physeal fracture healing?
- Limb length
- Angulation (altered joint reaction, biomechanical stresses)
What is the difference between a closed and open reduction?
- Closed = Done without surgical incision.
- Open = Surgical access.
What are some indications for open reduction? (8)
- Risk with bed confinement secondary to trial of conservative interventions prohibitive.
- Decrease likelihood of success specific to Fx type.
- Fx/displacement of articular surfaces.
- Associated arterial injury.
- Multiple injuries.
- Cost.
- Failed closed reduction.
- Pathological Fx secondary to metastasis.
What are the types of fixation?
- Internal
- External
What are the goals of fixation? (3)
- ) Avoid subsequent soft tissue injury.
- ) Maintain bone length.
- ) Maintain alignment.
What are the (3) phases of Fx healing?
- Inflammatory
- Reparative
- Remodeling
- ________ Bone = callus formation
- ________ Bone = more direct osteoblastic activity
- Surgically Compressed Bone = more direct osteoblastic activity
- Cortical = callus formation
- Cancellous = more direct osteoblastic activity
What is a common immobilization/protection timeline for both adults and children?
- Adults = 6-8 weeks
- Children = 4-6 weeks
- Early excessive loading creates a risk for what?
- Is insufficient loading detrimental?
- Pseudoarthrosis (false joint)
- Yes
What are some factors that can affect healing and prognosis of fractures? (10)
- Age
- Degree of local trauma
- Extent of bone loss
- Immobilization
- Type of bone (cortical v. trabecular)
- Size of bone (diameter)
- Concomitant Health Conditions
- Hormones
- Approximation
- Blood supply
What are some reasons that fractures are missed? (5)
- Radiography not ordered
- Fractures not recognized on images
- More subtle Frxs may not be evident in initial studies
- Multiple injuries
- Pt Hx inadequate
What are some common sites of elusive fractures in the spine?
- C1/C2, C6/C7
- Osteoporotic compression Fx of T/L spine
What are some common sites of elusive fractures in the UE?
- Scaphoid (20%)
- Radial head
- Triquetrum
- Fracture-dislocation injuries of the forearm & wrist
What are some common sites of elusive fractures in the LE?
- Femoral neck
- Tibial plateau
- Lateral tibial plateau avulsion Frx (Segond Fx)
- Subtle Patella Frxs
- Calcaneus (10%)
